How to reduce risk of ACL injuries in girls

Female athletes are up to 8 times more likely to tear their ACL than boys.

As an orthopedic surgeon caring for young athletes, I see it again and again − a young female soccer player misses a year of playing due to an ACL tear, only to return the following year with a tear in the opposite knee.

A torn anterior cruciate ligament (ACL) is a common knee injury, especially among athletes. And in female athletes, it’s up to 8 times more common than in boys.

Parents and coaches alike often ask me if there’s a way to prevent ACL tears in girls.

The short answer: yes. There may be ways to decrease the chance that your daughter will have to suffer through an ACL injury.

Over the past decade, training programs have been developed, which have been shown to decrease the risk of ACL injuries in most cases.

One such training program is Sportsmetrics™ developed by Dr. Frank Noyes at Cincinnati SportsMedicine and Orthopaedic Center.

This program consists of 20 exercises in 20 minutes, beginning 6 weeks to 1 month prior to the season and continuing throughout the season. Sportsmetrics focuses on muscle and joint preparation, strength, flexibility, agility and plyometrics, which involves correct body alignment and form while jumping and pivoting.

Akron Children’s Sports Medicine and Rehab has such a program and can train girls properly in these exercises.

A second and more recently developed program by Dr. Bert Mandelbaum, team physician for the U.S. soccer national teams, also focuses on neuromuscular training that can be done before and during the season.

His prevention program, called PEP, focuses on a combination of plyometrics, stretching and hip-strengthening exercises that are done 3 times a week for 15 minutes. Videos instruct the girls on stretching techniques for the trunk and lower extremities, strengthening exercises, plyometric activities such as jumping, and soccer-specific agility drills.

More than 1,000 female athletes were trialed on the PEP system in 2000, and the study demonstrated an 88 percent decrease in ACL injury in patients who performed the exercises.

Evidence certainly supports that these programs can be helpful, and more importantly, there’s little or no risk associated with doing them.

Weight a factor in ACL injury risk

The second factor that has been clearly shown to impact the chance of a girl or any athlete suffering an ACL tear is overall weight. Body Mass Index – which estimates how much body fat a person has based on her height and weight – tells us that the higher the BMI, the higher the risk she’ll sustain an ACL tear.

This is true not only of an ACL injury, but many other muscular injuries as well. So, keeping fit can keep these girls out of the OR.

High-risk sports

The final consideration is that basketball and soccer have the highest association of ACL tears in girls. I have an endless schedule of girls coming through my office with ACL tears from noncontact injuries from these 2 sports.

Parents need to understand that these are high-risk sports and should weigh their risks and benefits.

Knee braces won’t prevent injury

It’s a common myth that knee braces can prevent ACL tears. The only time knee braces have been shown to be beneficial in preventing any knee injury is with collateral ligament injuries of the knee in college football players playing on the offensive and defensive line.

No other study has been able to demonstrate decreased risk using a knee brace.

So while we can’t eliminate all ACL tears in girls, or for that matter, even in boys, there are some simple steps that will help keep these girls out of my operating room and on the field.

Dr. Kerwyn Jones is the chairman of Akron Children's Hospital's nationally-ranked division of orthopedics. Board certified in orthopedics with a subspecialty certificate in sports medicine, he has about 15 years of experience, and serves as a team doctor for the Copley School District. He and his wife, Beth, have 2 sons who are active in sports.